Nasolabial flap combined with auricle composite tissue flap in reconstructing of nasal alar full thickness defects after excision of basal cell carcinoma_West China Medical Journal

Authors：

MA Shaowei ¹ , LI Hancong ² , ZHOU Siqi ² , CEN Ying ¹ , QING Yong ¹ ,  WU Junliang ¹

1. Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WU Junliang, Email: wjlpiaoxiang@163.com

Keywords：

Auricle composite tissue flap; nasolabial flap; nasal alar full-thickness defect; basal cell carcinoma

DOI：

10.7507/1002-0179.202303217

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the approach of using a nasolabial flap in conjunction with an auricular composite tissue flap with the skin on the dorsal aspect of the auricle excised for the restoration of full-thickness defects of the nasal ala following the removal of basal cell carcinoma. Methods The data of unilateral nasal alar full-thickness defect after basal cell carcinoma surgery at Department of Plastic and Burn Surgery of West China Hospital, Sichuan University between January 2016 and January 2018 were selected. All patients had full-thickness defects of the unilateral nasal ala after surgery. According to the size of the defect, the nasal labial sulcus flap combined with the auricular composite tissue flap with the skin on the back of the auricle removed was used for nasal ala repair and reconstruction in the first stage. The pedicle division of the flap was performed in the second stage one month after the surgery. The observation contents included: the survival situation of the flap and the auricular composite tissue flap, the recurrence situation of the tumor, the appearance of the affected nasal ala, the scar situation in the surgical area, and the patient satisfaction. Results A total of 18 patients were included. Among them, there were 5 males and 13 females. All 18 patients were followed up for 36 months postoperatively. The postoperative flaps and auricular composite tissue flaps survived favorably, and no tumor recurrence was detected. The contour of the affected nasal ala was satisfactory, the surgical scars were inconspicuous, and the nasofacial angle was effectively maintained. All patients expressed satisfaction with the appearance of the nose and the facial profile. Conclusions The two-stage surgical repair protocol involving the use of a nasolabial flap in combination with an auricular composite tissue flap with the skin on the back of the auricle removed for repairing the full-thickness defect of the nasal ala after basal cell carcinoma of the nasal ala is straightforward in execution. It can yield a favorable nasal ala appearance postoperatively and adequately safeguard the nasofacial angle from impairment. Thus, it merits extensive application and promotion.

Citation： MA Shaowei, LI Hancong, ZHOU Siqi, CEN Ying, QING Yong, WU Junliang. Nasolabial flap combined with auricle composite tissue flap in reconstructing of nasal alar full thickness defects after excision of basal cell carcinoma. West China Medical Journal, 2024, 39(12): 1893-1898. doi: 10.7507/1002-0179.202303217 Copy

1.	Menick FJ. Nasal reconstruction. Plast Reconstr Surg, 2010, 125(4): 138e-150e.
2.	潘新良. 头颈部组织缺损修复与功能重建. 中华耳鼻咽喉头颈外科杂志, 2011, 46(5): 355-357.
3.	Zbacnik AP, Rawal A, Lee B, et al. Cutaneous basal cell carcinosarcoma: case report and literature review. J Cutan Pathol, 2015, 42(11): 903-910.
4.	Drake LA, Ceilley RI, Cornelison RL, et al. Guidelines of care for basal cell carcinoma. The American Academy of Dermatology Committee on Guidelines of Care. J Am Acad Dermatol, 1992, 26(1): 117-120.
5.	Thomas DJ, King AR, Peat BG. Excision margins for nonmelanotic skin cancer. Plast Reconstr Surg, 2003, 112(1): 57-63.
6.	Thorne CH, Chung KC, Gosain AK, et al. Grabb and Smith’s plastic surgery. 6th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.
7.	Baker SR, Johnson TM, Nelson BR. The importance of maintaining the alar-facial sulcus in nasal reconstruction. Arch Otolaryngol Head Neck Surg, 1995, 121(6): 617-622.
8.	Kakinuma H, Iwasawa U, Honjoh M, et al. A composite nasolabial flap for an entire ala reconstruction. Dermatol Surg, 2002, 28(3): 237-240.
9.	Bouhanna A, Bruant-Rodier C, Himy S, et al. Reconstruction of the nasal alar defect with the superiorly based nasolabial flap described by Burget: report of seven cases. Ann Chir Plast Esthet, 2008, 53(3): 272-277.
10.	Fujiwara M. One-stage reconstruction of an alar defect using a bilobed nasolabial-nasal tip flap based on the aesthetic subunits in orientals: case report. Aesthetic Plast Surg, 2004, 28(1): 13-16.
11.	Skaria AM. Repair of full-thickness nasal alar defect. Dermatol Surg, 2003, 29(1): 89-90.
12.	Selçuk CT, Ozalp B, Durgun M, et al. Reconstruction of full-thickness nasal alar defects using cartilage-supported nonfolded nasolabial flaps. J Craniofac Surg, 2012, 23(6): 1624-1626.
13.	Qian C, Yaodong X, Xiaoming H, et al. Repair of full - thickness alar defects. Dermatol Surg, 2012, 38(10): 1639-1644.
14.	Durgun M, Özakpınar HR, Selçuk CT, et al. Repair of full-thickness nasal alar defects using nasolabial perforator flaps. Ann Plast Surg, 2015, 75(4): 414-417.
15.	Ascari - Raccagni A, Baldari U. Turn-over lining flaps to repair full-thickness alar defects. J Eur Acad Dermatol Venereol, 2002, 16(4): 418-419.
16.	Hosaka Y, Tsukagoshi T, Sasaki E, et al. The use of otherwise redundant skin to provide nasal lining in the reconstruction of full - thickness alar defects by nasolabial flap repair. Br J Plast Surg, 1999, 52(1): 29-32.
17.	Tornero J, Cruz-Toro P, Farré A, et al. Free radial forearm flap in head and neck: our experience. Acta Otorrinolaringol Esp, 2014, 65(1): 27-32.
18.	Riecke B, Assaf AT, Heiland M, et al. Local full - thickness skin graft of the donor arm - a novel technique for the reduction of donor site morbidity in radial forearm free flap. Int J Oral Maxillofac Surg, 2015, 44(8): 937-941.
19.	Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir, 2002, 34(4): 239-244.
20.	Thankappan K, Kuriakose MA, Chatni SS, Sharan R, et al. Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome. Ann Plast Surg, 2011, 66(3): 261-266.
21.	Chen SL, Chen TM, Dai NT, et al. Medial sural artery perforator flap for tongue and floor of mouth reconstruction. Head Neck, 2008, 30(3): 351-357.
22.	宋晓萌, 张玮, 武和明, 等. 腓肠内侧动脉穿支皮瓣修复颊癌术后缺损的初步应用. 组织工程与重建外科杂志, 2014, 10(5): 269-271.
23.	Cinar C, Arslan H, Ogur S, et al. Free rectus abdominis myocutaneous flap with anterior rectus sheath to provide the orbital support in globe - sparing total maxillectomy. J Craniofac Surg, 2006, 17(5): 986-991.
24.	Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
25.	莫康楠, 王可敬. 游离皮瓣在头颈部软组织缺损重建中的应用进展. 国际耳鼻咽喉头颈外科杂志, 2019, 43(1): 27-31.
26.	许波, 郑荆洲, 张泽. 容量移位整形术修复乳腺癌保乳术后乳房缺损的临床疗效观察. 中国普外基础与临床杂志, 2024, 31(1): 74-79.

1. Menick FJ. Nasal reconstruction. Plast Reconstr Surg, 2010, 125(4): 138e-150e.
2. 潘新良. 头颈部组织缺损修复与功能重建. 中华耳鼻咽喉头颈外科杂志, 2011, 46(5): 355-357.
3. Zbacnik AP, Rawal A, Lee B, et al. Cutaneous basal cell carcinosarcoma: case report and literature review. J Cutan Pathol, 2015, 42(11): 903-910.
4. Drake LA, Ceilley RI, Cornelison RL, et al. Guidelines of care for basal cell carcinoma. The American Academy of Dermatology Committee on Guidelines of Care. J Am Acad Dermatol, 1992, 26(1): 117-120.
5. Thomas DJ, King AR, Peat BG. Excision margins for nonmelanotic skin cancer. Plast Reconstr Surg, 2003, 112(1): 57-63.
6. Thorne CH, Chung KC, Gosain AK, et al. Grabb and Smith’s plastic surgery. 6th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007.
7. Baker SR, Johnson TM, Nelson BR. The importance of maintaining the alar-facial sulcus in nasal reconstruction. Arch Otolaryngol Head Neck Surg, 1995, 121(6): 617-622.
8. Kakinuma H, Iwasawa U, Honjoh M, et al. A composite nasolabial flap for an entire ala reconstruction. Dermatol Surg, 2002, 28(3): 237-240.
9. Bouhanna A, Bruant-Rodier C, Himy S, et al. Reconstruction of the nasal alar defect with the superiorly based nasolabial flap described by Burget: report of seven cases. Ann Chir Plast Esthet, 2008, 53(3): 272-277.
10. Fujiwara M. One-stage reconstruction of an alar defect using a bilobed nasolabial-nasal tip flap based on the aesthetic subunits in orientals: case report. Aesthetic Plast Surg, 2004, 28(1): 13-16.
11. Skaria AM. Repair of full-thickness nasal alar defect. Dermatol Surg, 2003, 29(1): 89-90.
12. Selçuk CT, Ozalp B, Durgun M, et al. Reconstruction of full-thickness nasal alar defects using cartilage-supported nonfolded nasolabial flaps. J Craniofac Surg, 2012, 23(6): 1624-1626.
13. Qian C, Yaodong X, Xiaoming H, et al. Repair of full - thickness alar defects. Dermatol Surg, 2012, 38(10): 1639-1644.
14. Durgun M, Özakpınar HR, Selçuk CT, et al. Repair of full-thickness nasal alar defects using nasolabial perforator flaps. Ann Plast Surg, 2015, 75(4): 414-417.
15. Ascari - Raccagni A, Baldari U. Turn-over lining flaps to repair full-thickness alar defects. J Eur Acad Dermatol Venereol, 2002, 16(4): 418-419.
16. Hosaka Y, Tsukagoshi T, Sasaki E, et al. The use of otherwise redundant skin to provide nasal lining in the reconstruction of full - thickness alar defects by nasolabial flap repair. Br J Plast Surg, 1999, 52(1): 29-32.
17. Tornero J, Cruz-Toro P, Farré A, et al. Free radial forearm flap in head and neck: our experience. Acta Otorrinolaringol Esp, 2014, 65(1): 27-32.
18. Riecke B, Assaf AT, Heiland M, et al. Local full - thickness skin graft of the donor arm - a novel technique for the reduction of donor site morbidity in radial forearm free flap. Int J Oral Maxillofac Surg, 2015, 44(8): 937-941.
19. Gedebou TM, Wei FC, Lin CH. Clinical experience of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir, 2002, 34(4): 239-244.
20. Thankappan K, Kuriakose MA, Chatni SS, Sharan R, et al. Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome. Ann Plast Surg, 2011, 66(3): 261-266.
21. Chen SL, Chen TM, Dai NT, et al. Medial sural artery perforator flap for tongue and floor of mouth reconstruction. Head Neck, 2008, 30(3): 351-357.
22. 宋晓萌, 张玮, 武和明, 等. 腓肠内侧动脉穿支皮瓣修复颊癌术后缺损的初步应用. 组织工程与重建外科杂志, 2014, 10(5): 269-271.
23. Cinar C, Arslan H, Ogur S, et al. Free rectus abdominis myocutaneous flap with anterior rectus sheath to provide the orbital support in globe - sparing total maxillectomy. J Craniofac Surg, 2006, 17(5): 986-991.
24. Heitmann C, Guerra A, Metzinger SW, et al. The thoracodorsal artery perforator flap: anatomic basis and clinical application. Ann Plast Surg, 2003, 51(1): 23-29.
25. 莫康楠, 王可敬. 游离皮瓣在头颈部软组织缺损重建中的应用进展. 国际耳鼻咽喉头颈外科杂志, 2019, 43(1): 27-31.
26. 许波, 郑荆洲, 张泽. 容量移位整形术修复乳腺癌保乳术后乳房缺损的临床疗效观察. 中国普外基础与临床杂志, 2024, 31(1): 74-79.

West China Medical Journal

Nasolabial flap combined with auricle composite tissue flap in reconstructing of nasal alar full thickness defects after excision of basal cell carcinoma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content